Royal Pregnancy Calls Attention to Hyperemesis Gravidarum (HG)

Britain’s royal family made headlines earlier this month when it announced that the Dutchess of Cambridge, Kate Middleton, was expecting her third child. At that time, it was also revealed that the future queen was suffering from Hyperemesis Gravidarum (HG), just as she had in her earlier pregnancies.

According to the American Pregnancy Association, Hyperemesis Gravidarum (HG) is distinguishable from the more common form of morning sickness in that the nausea does not go away, is accompanied by severe vomiting, and vomiting that causes severe dehydration. In addition, women with Hyperemesis Gravidarum (HG) cannot keep their food down.

Hyagriv N. Simhan, MD, MS, medical director of obstetrical services at Magee-Women's Hospital at the University of Pittsburgh Medical Center tells Healio Family Medicine the condition “complicates” about 1 to 3 percent of all pregnancies.

Though the condition is rare, it can be severe, according to the Hyperemesis Education and Research Foundation. This group also states that diagnosis is typically made by looking for ketones, measuring weight loss, and evaluating how well the mother can perform her normal daily activities.

As a service to its readers, Healio Family Medicine consulted several experts for additional information about hyperemesis. Here’s what you need to know:

Why it happens

“Hyperemesis Gravidarum (HG) is thought to occur because of the brain’s response to the pregnancy hormone, hCG. Conditions where the hCG level is very high (eg, twins or triplets) can make Hyperemesis Gravidarum (HG) more likely,” Simhan said, adding that some women are more sensitive to hCG than others. “We don’t understand why that may be, but some women experience much more severe nausea and vomiting than others, despite having a comparable hCG level.”

Risk factors

There are a number of factors that place a woman at higher risk for Hyperemesis Gravidarum (HG), according to the Hyperemesis Education and Research Foundation. This group states that these include, but are not limited to: untreated asthma, high saturated fat diet, and posttraumatic stress disorder. In addition, patients who have a history of kidney disease, gall bladder disease, allergies and motion sickness are also among those at risk for Hyperemesis Gravidarum (HG).

Questions to ask patients

Simhan suggested that medical professionals query patients regarding how many times they are vomiting, as well as the trajectory of weight loss/gain to distinguish between Hyperemesis Gravidarum (HG) and the more common form of morning sickness.

Signs it’s not morning sickness

According to the Hyperemesis Education and Research Foundation, women who lose five to 20 pounds or more, have nausea that keeps them from wanting to eat or drink, vomit often and vomit bile or blood if the nausea is left untreated may have Hyperemesis Gravidarum (HG).

Treatment

“Treatment of Hyperemesis Gravidarum (HG) focuses on therapies to reduce the feeling of nausea, treatment of associated conditions (such as reflux), correction of dehydration and electrolyte abnormalities with oral or IV hydration, and nutritional replacement therapy,” Simhan said. “To alleviate nausea, we generally start with behavioral therapy – altering food choices and timing of meals, as well as strategies like acupressure. When necessary we move on to anti-nausea medications or to other forms of feeding, some of which avoid the stomach.”

If you or someone you know suffers from Hyperemesis Gravidarum (HG) please check out this amazing tool that the HER Foundation has created to help HG Sufferers. The HER Foundation requests your support in regards to users testing the APP's success to ensure that the APP will be successful and available now and in the future.

UCLA Health is partnering with the HER Foundation on the first HG App. It released early September for user testing and we need your help! It will only take about 5 minutes to input your symptoms and food/fluids each day. You must be pregnant, sick with nausea/vomiting, using an iPhone and apps, and speak English. See the full details below. If you don’t qualify or are not currently pregnant, you can help by sharing this with your friends and on social media. If you are interested in trying out our new HG Care app, please contact Dr. Marlena Fejzo at mfejzo@mednet.ucla.edu.

We need 200 women to make this successful! If we don’t get enough users, the app may not be completed so please help us find women to participate as soon as possible.

QUALIFICATIONS:1. Tech Savvy Mom (just be familiar with using apps),2. Use an iPhone,3. Speak English (doctor and patient),4. Have more severe pregnancy nausea/vomiting being treated during the month of September, and5. Visit a doc who will answer a simple 3 question survey and review the summary data from the app.

You will be one of the first to try out the HG Care app on your iPhone! If you are currently suffering from nausea and vomiting of pregnancy and are interested in trying out our new HG Care app, please contact Dr. Fejzo at mfejzo@mednet.ucla.edu.

• You will be asked to download the App on your phone,• Use the App daily for a minimum of the 7 days prior to your next OB visit. (About 5 minutes daily.)• Print 2 copies of the report (insight page of the App) within 24 hours prior to the next OB visit.• We ask you and your OB/Provider to fill out and sign the App success survey, a simple 3-question survey at the bottom of the printed report page of the App.• We ask you to return the signed survey answers via scan/email.

Please note: this is a research study and participation is voluntary. Your decision whether or not to participate will not affect the treatment you are currently receiving nor your relationship with your healthcare provider.